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Status Report On Conservatee CI-12 - California

Status Report On Conservatee Form. This is a California form and can be used in Probate San Joaquin Local County .
 Fillable pdf Last Modified 2/14/2011
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SUPERIOR COURT INVESTIGATORS 2826 SUPERIOR COURT OF SAN JOAQUIN COUNTY In The Conservatorship of: PHONE: (209) 468FAX: (209) 468- REPORT TO THE COURT ON THE STATUS OF CONSERVATEE CASE NUMBER I, _____________________________am the Conservator of the above-named Conservatee and my status report is as follows: 1. Present age of the Conservatee: ____________ Conservatee's Date of birth: ______________ 2. Current Living arrangements of the Conservatee: A. Name of care facility/board and care: _________________________________________ B. Current address: _________________________________________________________ _________________________________________________________ C. D. Phone number of Conservatee: __________________________________________________ The Conservatee's residence is own home/apartment Conservator's home/apartment nursing home hospital or medical facility boarding home relative's home (relationship) ________________ other (specify)__________ The Conservatee has been in the present residence since (date):_____________. If moved within the past year, state reason(s) for change: ____________________________________________ I rate the Conservatee living arrangement as Excellent Average Below average (Explain)_____________________________________________________________________ I believe the Conservatee is: content with the living situation unhappy with the living situation I recommend a more suitable living arrangement for the adult as follows: ________________________________________________________________________________ ________________________________________________________________________________ E. F. G. H. 3. Physical Health A. I believe that the Conservatee's current physical condition is Excellent Good Fair Poor B. During the past year the Conservatee's physical condition has: remained about the same improved (Explain) _________________________________________________ worsened (Explain)_________________________________________________ C. During the past year the Conservatee received the following medical treatment; (Include check-ups and dental): Date Ailment Type of Treatment Doctor's Name __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ CI-12 (01/11) STATUS REPORT ON CONSERVATEE CONFIDENTIAL American LegalNet, Inc. www.FormsWorkFlow.com 4. Mental Health A. I believe the Conservatee's current mental condition is Excellent Good Fair Poor B. During the past year the Conservatee's mental condition has: remained about the same. improved (Explain) _________________________________________________________ worsened (Explain) ________________________________________________________ C. During the past year, treatment or evaluation by a psychologist or social worker: was provided was not provided __________________________________________________ D. IF conservatee is a client of Valley Mountain Regional Center please provide: (Case Manager Name):_________________________________ (Phone Number):___________________ 5. Social Activities/Services A. The conservatee's social condition is Excellent Good Fair Poor B. During the past year, the Conservatee's social condition has: remained about the same improved (Explain) ______________________________________ C. IF conservatee participates in a day-program please provide Name of Program: ______________________________________________ Address: _____________________________________________________ Phone Number: ________________________________________________ D. During the past year, the Conservatee has participated in the following activities: Recreational _____________________________________________________________________ Educational ______________________________________________________________________ Social ___________________________________________________________________________ Occupational _____________________________________________________________________ Other organizations/programs the Conservatee participates in; describe: ______________________ ___________________________________________________________________________________ If the conservatee does not attend a day-program, please explain why: ________________________ ____________________________________________________________________________________ 6. List of Visits Please check this box if the conservatee lives with the conservator. A. The last visit to the conservatee was on __________. During the past year, I visited the Conservatee as follows:_____________________________________________________________________________ _____________________________________________________________________________________ B. The average amount of time I spent on each visit was: _______________________________________ 7. I intend to change or I request the court to be able to change the following: A. The Conservatee's living arrangement (describe);___________________________________________ ______________________________________________________________________________________ B. The current financial management of estate including the sale of any assets (describe); ______________________________________________________________________________________ ______________________________________________________________________________________ 8. The conservatorship should be should not be continued because: ______________________________________________________________________________________ ______________________________________________________________________________________ 9. A. I am the Conservator of the Person Only for the Conservatee. B. I am the Conservator of the Person and Estate and my accounting will be filed separately. ___________________________________ Address: ___________________________ Check if (Signature) _____________________________________ _________________________________________________ (Date) new address Phone: ___________________________ Check if new phone # CI-12 (01/11) STATUS REPORT ON CONSERVATEE CONFIDENTIAL American LegalNet, Inc. www.FormsWorkFlow.com
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